Anesthetic management with sevoflurane combined with alfaxalone-medetomidine constant rate infusion in a Thoroughbred racehorse undergoing a long-time orthopedic surgery

Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature

Simple Summary

Recovery is the most dangerous phase of general anaesthesia in horses. Numerous publications have reported about this phase, but structured reviews that try to reduce the risk of bias of narrative reviews/expert opinions, focussing on the topic are missing. Therefore, the aim of the present article was to publish the first structured review as a summary of the literature focussing on the recovery phase after general anaesthesia in horses. The objective was to summarise the available literature, taking into account the scientific evidence of the individual studies. A structured approach was followed with two experts in the field independently deciding on article inclusion and its level of scientific evidence. A total number of 444 articles, sorted by topics and classified based on their levels of evidence, were finally included into the present summary. The most important findings were summarised and discussed. The present structured review can be used as a compilation of the publications that, to date, focus on the recovery phase after general anaesthesia in adult horses. This type of review tries to minimise the risk of bias inherent to narrative reviews/expert opinions.

Abstract

Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews.

Clinical pharmacokinetics and pharmacodynamics of intravenous alfaxalone in young Thoroughbred horses premedicated with medetomidine and midazolam

To investigate the clinical pharmacokinetics and pharmacodynamics of intravenous alfaxalone in young Thoroughbred horses, seven Thoroughbred horses were randomly anaesthetised twice with either 1 or 2 mg/kg of intravenous alfaxalone after premedication with medetomidine (6 µg/kg intravenous) and midazolam (20 µg/kg intravenous). Blood samples were collected at predetermined time points up to two hours after administration. Plasma alfaxalone concentrations were quantified by a liquid chromatography tandem-mass spectrometry method and analysed by non-compartmental pharmacokinetic analysis. Induction and recovery qualities were good to excellent for both doses. Recovery time for the 2 mg/kg (median 90 minutes) was significantly longer than that for the 1 mg/kg (median 50 minutes). Respiratory rate for the 2 mg/kg was significantly lower than that for the 1 mg/kg, resulting in hypoxaemia. The median (range) elimination half-life, total clearance and volume of distribution were 58.2 (42.3-70.7) minutes, 11.6 (10.3-14.5) ml/minute/kg and 0.8 (0.7-0.9) l/kg for the 1 mg/kg and 59.8 (47.5-68.0) minutes, 14.7 (12.1-16.0) ml/minute/kg and 0.9 (0.9-1.2) l/kg for the 2 mg/kg, respectively. Alfaxalone is rapidly eliminated from the plasma in young Thoroughbred horses. Respiratory depression should be especially noted when alfaxalone is used in clinical practice.

Clinical Efficacy of Trimetazidine and Holistic Management in the Treatment of Coronary Heart Disease

BACKGROUND

To investigate the clinical efficacy of trimetazidine and holistic management in the treatment of coronary heart disease.

METHODS

A total of 128 cases of patients with coronary heart disease were admitted in The Second Affiliated Hospital of Dalian Medical University from October 2014 to June 2017. These patients were divided into control group and experimental group, with 64 patients each. The patients in the control group underwent conventional treatment. On this basis, the patients in the experimental group were treated with trimetazidine. Both groups underwent holistic management. The clinical conditions, echocardiography indexes, life quality, and mental states of patients were compared between the two groups.

RESULTS

The total efficient rate of patients in the control group was significantly lower than that of the experimental group, and the difference was statistically significant (P<0.05). After treatment, the left ventricular ejection fraction of patients in the experimental group was higher than that of the control group; the left ventricular end diastolic diameter and left ventricular posterior wall thickness of patients in the experimental group were lower than those of the control group, and the differences were statistically significant (P<0.05). The physiological health score, mental health score, Hamilton Depression Scale and Hamilton Anxiety Rating Scale of patients were significantly decreased compared with the control group, and the differences were statistically significant (P<0.05).

CONCLUSION

The efficacy of trimetazidine in the treatment of coronary heart disease is definite. The assisting holistic management can significantly improve the mental status and life quality of patients by enhancing the cardiac function, which has clinical reference and promotion values.